Myrobalan (2016) and Gout

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Two species of a tropical plant, Black Myrobalan (Terminalia chebula) and Beleric (Terminalia bellirica) were investigated for their efficacy in lowering uric acid levels in patients with hyperuricemia as compared to a medication commonly prescribed for the condition.

In a double-blind, placebo-controlled pilot study researchers gave 110 patients with high uric acid levels placebo, twice a day Myrobalan (500mg T. chebula, 500mg or 250mg T. bellirica), or 40mg of the drug febuxostat. They found that Myrobalan was as effective as the drug, that T. bellirica was more effective than T. chebula, and that the larger dose of T. bellirica was more effective than the smaller dose.

During the trial some of the patients taking febuxostat reported side effects such as nausea, but none of the patients taking Myrobalan reported any problems nor was their blood chemistry negatively impacted.

Researchers: P. Usharani, C. Nutalapati, et al,
Published: A randomized, double-blind, placebo-, and positive-controlled clinical pilot study to evaluate the efficacy and tolerability of standardized aqueous extracts of Terminalia chebula and Terminalia bellerica in subjects with hyperuricemia, Clinical Pharmacology, June, 2016.

Editor's Note

We find the study interesting because although high uric acid levels in the blood are associated with gout:

  • these high levels develop before symptoms of gout appear, and
  • high uric acid levels are also associated with higher risk of heart disease, cerebrovascular disease, and early death.

The body normally makes biochemicals called purines which play important roles in DNA and RNA functioning. They are found mostly in red meats and organ meats and moderate amounts in poultry, fish, and some vegetables.

However, when the diet includes large amounts of red meat and organ meats such as liver, sweetbreads, game meats, some fish like sardines, then almost all of the excess is converted to uric acid. Over the long term the excess is converted to a needle-like salt giving rise to excruciating pain in the big toe and other joints.

Gout medications, such as febuxostat have side effects, especially impacting liver health, but which can include heart problems and strokes, so there has been a search for safer alternatives.